Study Finds Certain Coping Strategies Impact Recovery from Stroke

Following a stroke, almost two-thirds of people turn to religion on a regular basis and about 12 percent frequently use humor to cope with the stress that results from having a stroke. That's according to researchers at the University of Maryland School of Medicine in Baltimore, who also found that about two-thirds of stroke patients use acceptance as a way to move forward and deal with their new challenges.

Results of the study, which showed that certain coping strategies enable people to adjust better to life after a stroke, were presented at the American Heart Association's 27th International Stroke Conference in San Antonio, Texas, on February 7, 2002.

The study evaluated the coping style and psychological adjustment of 56 stroke survivors treated at the University of Maryland Medical Center (34 women and 22 men) one year after their stroke. The most common strategies among the patients were turning to religion, acceptance, and positive reinterpretation and growth, which means that they tried to find something positive from their experience, shifted their priorities, and gained new appreciation for their family and friends. Almost half of the patients studied used positive reinterpretation and growth on a daily basis.

While many patients use a variety of coping strategies, the researchers looked at the most dominant ones used on a regular basis by patients in the study.

"Individuals who used humor and positive reinterpretation were more outgoing, active, and positive a year after their stroke," says the study's lead author, Lynn Grattan, Ph.D., an associate professor of neurology at the University of Maryland School of Medicine and a neuropsychologist at the University of Maryland Medical Center.

"Turning to religion can also help patients cope effectively following a stroke, especially if they are using it to seek strength to deal with the challenges they face," says Dr. Grattan.

The researchers also found that stroke patients who avoided addressing the issues related to their stroke had higher levels of depression one year after the stroke. These individuals used "behavioral disengagement" as a coping strategy, acting as though their stroke didn't happen and diverting their attention away from activities that would help them with rehabilitation and recovery. For example, they may have skipped follow-up doctor or physical therapy appointments or ignored recommendations on diet, exercise and other lifestyle changes to prevent a future stroke. Behavioral disengagement was used frequently by seven percent of patients in the study.

A stroke can lead to feelings of frustration, anxiety, anger, apathy or depression. By avoiding the emotional and behavioral aspects of what they went through, Dr. Grattan says patients who disengage are not dealing with natural feelings of loss and are not allowing themselves to take steps that could improve their condition.

"We believe these findings are important to keep in mind as we work with patients early in the recovery process," according to Dr. Grattan.

"Two people with the same stroke-related disabilities can have very different outcomes. One person may return to work and social activities, while the other may end up on permanent disability. We believe pre-stroke personality and coping strategies play a major role in how well patients recover," she adds.

Dr. Grattan says health care providers should first assess the patient's dominant coping style and tailor therapy to that individual. "Through counseling, stroke support groups and other methods, we can encourage patients to use the most effective coping strategies, especially during the year following a stroke, to maximize their adjustment and recovery," she says.

In a related study, Dr. Grattan and her colleagues found that patients who had adjusted most successfully one year after their stroke had received support from family and friends. The most useful types of support included driving them to doctor appointments, picking up prescriptions, and empathic listening, which means listening with sensitivity to the person's needs ad point of view without being judgmental.

Stroke is the leading cause of serious disability among adults. About 600,000 people suffer from a stroke each year in the U.S.

The following University of Maryland School of Medicine researchers collaborated with Dr. Grattan on the study: Natasha Kabitski, Marjan Ghahramanlou, Christopher Vaughan, Marcella Wozniak, Steven Kittner and Thomas Price.

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